scholarly journals Graves' ophthalmopathy: III. Effect of transantral orbital decompression on optic neuropathy.

1988 ◽  
Vol 72 (9) ◽  
pp. 683-687 ◽  
Author(s):  
E S Hallin ◽  
S E Feldon ◽  
J Luttrell
2005 ◽  
Vol 19 (6) ◽  
pp. 603-606 ◽  
Author(s):  
Jan L. Kasperbauer ◽  
Lucinda Hinkley

Background Graves’ ophthalmopathy generates a volume excess for the orbital cavity, which may produce proptosis, pain, exposure keratitis, diplopia, and optic neuropathy. Endoscopic orbital decompression expands the orbital cavity into the ethmoid cavity and medial maxillary sinus. This retrospective study documents the outcomes after endoscopic orbital decompression for patients with Graves’ ophthalmopathy. Methods Data collected included demographic information, symptom resolution, complications related to the surgery, reduction in proptosis, subsequent need for eye muscle surgery, and hospital length of stay. Between July 1989 and April 2003, 62 patients were referred for endoscopic orbital decompression (often unilateral). Results Three patients refused use of their medical records for research purposes. Seventy percent were women; the average age of the study group was 49 years. Preoperatively, 63% of the patients had diplopia and optic neuropathy was noted in 27%. Two patients had a cerebrospinal fluid leak identified and managed during the decompression. No postoperative leaks occurred. Twenty-five percent of patients did not require eye muscle surgery. Forty-eight percent of the patients underwent one procedure to manage diplopia. The average reduction in proptosis was 2.5 mm. Fifty-four percent were managed as an outpatient and 27% underwent a 23-hour observation period. Conclusion This data supports the safety, efficiency, and efficacy of endoscopic orbital decompression for unilateral and bilateral Graves’ ophthalmopathy. Eye muscle surgery frequently will be required to manage diplopia after decompression. (American Journal of Rhinology 19, 603–606, 2005)


Author(s):  
J.D. Perry ◽  
Craig Lewis

In 1835 Graves first described the characteristic exophthalmos of thyroid eye disease, and his name has since become synonymous with thyrotoxic ophthalmopathy. Graves disease is relatively common, with a prevalence and incidence of 1% and 0.1%, respectively. Although subtle signs of ophthalmopathy are present in most patients with Graves disease, only 30% have obvious eye findings, and only 5% develop ophthalmopathy severe enough to warrant specific treatment with radiotherapy, immunosuppression, or orbital decompression surgery. Graves disease and Graves ophthalmopathy are more common in females than in males, though males tend to have more severe eye disease. Cigarette smokers have an increased risk of developing Graves disease, an increased risk of developing associated ophthalmopathy, and a progressively increased risk of severe ocular manifestations. While the onset of Graves disease usually occurs when people are in their forties, thyroid optic neuropathy tends to occur in the fifties and sixties, underscoring the importance of careful long-term follow-up of these patients. The ophthalmopathy of Graves disease is usually associated with hyperthyroidism, but it occurs in euthyroid and hypothyroid patients as well. The clinical course of the ophthalmopathy does not directly correlate with the thyroid status, although more than 80% of thyroid patients who develop severe ophthalmopathy do so within 18 months of the detection of the thyroid disease. The early findings of thyroid ophthalmopathy include conjunctival injection, lacrimation, ocular surface irritation, orbital and periorbital swelling, and mild eyelid retraction. Progression of the disease can result in severe orbital congestion, massive enlargement of the extraocular muscles with secondary diplopia, proptosis, compressive optic neuropathy, prominent eyelid retraction, spontaneous subluxation of the globe anterior to the eyelids, and exposure keratopathy. Treatment options for these serious complications of Graves disease include systemic corticosteroids, radiation therapy, and orbital decompression surgery. The role of radiation therapy in the management of Graves ophthalmopathy remains controversial. In 1973, Donaldson et al. first reported results of radiotherapy for Graves ophthalmopathy using a megavoltage linear accelerator. This series and multiple subsequent series have reported favorable results in approximately 60% of patients.


2015 ◽  
Vol 14 (3) ◽  
pp. 97-107
Author(s):  
Jerome How Ing Ha ◽  
James Leong ◽  
Peter Martin ◽  
Raf Ghabrial ◽  
Ross Benger

Purpose: To investigate the outcomes of orbital decompression surgery for dysthyroid optic neuropathy associated with severe Graves’ ophthalmopathy. Design: Ten years (2000-2010) retrospective case series.Methods: Thirty-eight orbits (with dysthyroid optic neuropathy) of 119 surgical orbital decompressions. Patients with dysthyroid optic neuropathy associated with Graves’ ophthalmopathy, who underwent orbital decompression surgery at Sydney Eye Hospital (Sydney, Australia), were investigated for outcome measures.Results: Thirty-five orbits were eligible for data analysis. Orbital decompression surgery improved visual acuity in 29 orbits and maintained visual acuity in four orbits. In patients with dysthyroid optic neuropathy, there was a statistically significant mean improvement in visual acuity of 2.8 lines postoperatively (standard deviation = 3.2; 95% confidence interval 3.9 to 1.7, p-value < 0.05). There were no statistically significant differences invisual acuity amongst different combinations of orbital walls being decompressed, with the majority of orbits had the medial orbital wall decompressed. This may reflect the small number of decompressions performed in each subgroup. Orbital decompression surgery reduced proptosis by a mean of 3.2 mm (standard deviation = 2.9; 95% confidence interval -4.32 to -2.07; p-value < 0.05). Medial and lateral orbital walls decompression resulted in the greatest mean reduction in proptosis. There were no severe visual impairment cases postoperatively (VA worse than 6/60). There were two patients with new onset diplopia postoperatively. There were three orbits with bleeding and one orbit with CSF leakage, all without major sequelae postoperatively.Conclusion: Regardless of surgical access, orbital decompression surgery is effective and safe in the management of dysthyroid optic neuropathy and in reducing proptosis in patients with Graves’ ophthalmopathy.


2015 ◽  
Vol 1 (2) ◽  
pp. e119-e122 ◽  
Author(s):  
Roberto Rocchi ◽  
Maria Antonietta Altea ◽  
Michele Marinò ◽  
Francesca Menconi ◽  
Marenza Leo ◽  
...  

Orbit ◽  
2011 ◽  
Vol 31 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Margarita Sánchez-Orgaz ◽  
Anna Grabowska ◽  
Arantza Royo-Oreja ◽  
Mónica Asencio-Durán ◽  
Ricardo Romero-Martín ◽  
...  

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